Q. I need a cup or two of coffee in the morning to get me going. My daughter, who follows a strict macrobiotic diet, has been nagging me about my coffee drinking. She contends that caffeine (I only drink caffeinated coffee) is an addictive drug that can cause all kinds of health problems. I have already stopped smoking and am on a strict low-fat diet. Do I really have to give up coffee?
A. Before I answer your question, let me tell you about an experience I recently had. Unbeknownst to me, my secretary decided that caffeine was unhealthy and began bringing me decaffeinated coffee in the morning. For days, I suffered from terrible headaches that nothing seemed to help. Seeing how miserable I was, my assistant finally confessed to what she had done and brought me a cup of real Miraculously, my headaches disappeared and I felt like my energetic self again.
I know from firsthand experience that caffeine is addicting. Although we don’t tend to think of it as such, caffeine is a drug – in fact, it is the most widely used drug in the world. Caffeine is found in foods, including chocolate, and beverages other than coffee, including tea and cola drinks. It is estimated that about 80% of the US population ingests caffeine in some form during the day. Once you begin using caffeine, it is hard to quit. Even moderate caffeine users who abstain from caffeine for even one day will experience withdrawal, including headache, fatigue, and flulike symptoms. This does not mean, however, that caffeine or coffee is dangerous. Even though caffeine is addictive, the amount that is normally found in one or two cups of coffee or tea appears to be harmless. For some, it may even be beneficial. For example, caffeine can improve mental alertness, combat fatigue, and even increase metabolism, which can help burn fat. Caffeine is also an excellent treatment for migraine headache since it dilates the blood vessels in the brain, thus reducing pain. The excessive use of caffeine is an entirely different issue. Too much caffeine – more than four or five cups daily – can cause nervousness, insomnia, aggravate high blood pressure, and even trigger heart palpitations and some people. Although caffeine is a stimulant, a high dose of caffeine over time can have just the opposite effect, especially if consumed with a sugary treat such as a doughnut. Both caffeine and sugar can cause a sudden surge in insulin, a hormone produced by the pancreas, which will put the body into overdrive, resulting in a mid-morning slump.
There have been many studies on the health effects of coffee and some have been extremely negative. For example, in 1981, a highly publicized study linked coffee drinking – with or without caffeine – to a substantially increased risk of pancreatic cancer. Another study linked coffee drinking to bladder cancer. And since there have been anecdotal reports linking caffeine to fibrocystic breast disease, some researchers speculated that it may also increase the risk of breast cancer. More recent studies, however, have not found any relationship between coffee and cancer of any kind. In fact, on closer examination of some of these studies, researchers concluded that coffee drinking was not the culprit, but that cigarette smoking was actually the cause of the increased cancer risk. Smokers drink twice as much coffee as non-smokers, so although it appeared as if people who consume the most coffee have the highest risk of cancer, in reality, the real risk was from their smoking.
Heavy caffeine users, however, do increase their risk of osteoporosis, a major threat for women. Women who drink caffeinated beverages lose more calcium in their urine than woman who abstain from caffeine. In fact, according to the famous Nurses’ Study (conducted by Harvard Medical School investigators who followed every conceivable aspect of the health and habits of over 100,000 nurses for several decades), Women who consumed more than 817 milligrams of caffeine daily (roughly the amount in six to seven cups of coffee) were at three times the risk of suffering a hip fracture. There is some good news to the story, at least for moderate coffee drinkers. Drinking just one glass of milk daily can replace the calcium loss caused by two cups of coffee.
If you drink caffeinated coffee in moderation and are not showing any ill effects, there is no need to stop. I would recommend, however, that you drink a glass of low-fat milk or eat a yogurt daily to restore the lost calcium. I am not, however, giving caffeinated coffee even in small amounts of a clean bill of health for everyone. Pregnant woman in particular should be cautious about caffeine use. Some studies have linked caffeine to delayed conception, premature birth, and fetal growth retardation, although others have not found any link. Even though we do not know for certain whether caffeine is harmful to the fetus, it is advisable for women to avoid it during pregnancy. If you have high blood pressure or a heart condition, it is also wise to reduce your intake of caffeine.
Dr. Marianne Legato, Professor Emerita of Clinical Medicine at Columbia University is an internationally known academic physician, author, lecturer, and specialist in gender-specific medicine. She is founding member of the International Society for Gender Medicine and also the founder and director of The Partnership for Gender-Specific Medicine at Columbia University and its next iteration, The Foundation for Gender-Specific Medicine. These enterprises are the first collaborations between academic medicine and the private sector focused solely on gender-specific medicine: the science of how normal human biology differs between men and women and of how the diagnosis and treatment of disease differs as a function of gender and sex. Her ground breaking textbook on Gender-and Sex Specific Medicine has been published in 2017 in the 3rd edition.
She has published extensively on Gender and Sex Specific Medicine, both scientifically and for the lay public. She is also the founding editor of the journal Gender Medicine, and the Journal Gender and Genome, published for the scientific community. In 1992, Dr. Legato won the American Heart Association’s Blakeslee Award for the best book written for the lay public on cardiovascular disease. She is a practicing internist in New York City and has been listed each year in New York Magazine’s “Best Doctors” since the feature’s inception in 1993.